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. e du/thir dc ir c uit_1999/176Filed June 29, 1999

UNITED STATES COURT OF APPEALS

FOR THE THIRD CIRCUIT

No. 98-5139

DARRYL LEON ROUSE

v.

WILLIAM PLANTIER, Acting Superintendent of A.D.T.C. ; SALLY S. SCHEIDEMANTEL, Resigning Superintendent of A.D.T.C.; WILLIAM H. FAUVER, Commissioner of N.J. Department of Corrections; GOVERNOR JIM FLORIO, State of New Jersey; DR. ROBERT CARDINALE, Medical Director of A.D.T.C.; DR. NARSHIMA REDDY, attending Physician of A.D.T.C.; MS. ELAINE MARTIN, Chief Nur se of A.D.T.C.; CAPTAIN HELMKIN, Housing; MIKE ZELL, Director of Social Services; DR. SANDOVAL, Attendin g Psychologist of A.D.T.C.; DR. CATTONE, M.D., St. Fr ancis Hospital; SCOTT FAUNCE; DR. TARLIAN, M.D.; DR. O'BRYNE, M.D.; DR. TODD, M.D., St. Francis Hospital ; CHARLES BROOKS, on behalf of a class of themselves and others similarly situated; STEPHEN JANKOWSKI, o n behalf of a class of themselves and others similarl y situated; JULIO BAEZ, on behalf of a class of thems elves and others similarly situated; ROBERT KAMMERER,

on behalf of a class of themselves and others similarly situated

v.

ELAINE ALLEN; JOHN DOE; JANE ROE

WILLIAM PLANTIER; ROBERT CARDINALE; NARSHIMA REDDY; ELAINE ALLEN,

AppellantsON APPEAL FROM THE

UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF NEW JERSEY (D.C. No. 90-cv-03511) (District Judge: Honorable Stephen M. Orlofsky)

Argued: January 14, 1999

Before: NYGAARD, ALITO, and LEWIS, Circuit Judges

(Opinion Filed: June 29, 1999)

PETER VERNIERO Attorney General of New Jersey

JOSEPH L. YANNOTTI Assistant Attorney General
MARY C. JACOBSEN (ARGUED) Assistant Attorney General

JAYROE WURST Deputy Attorney General

WILLIAM P. FLAHIVE Deputy Attorney General

Office of Attorney General

CN 112 R.J. Hughes Justice Complex Trenton, New Jersey 08106-0112

Counsel for Appellants

LAWRENCE S. LUSTBERG MARK A. BERMAN (ARGUED)

Gibbons, Del Deo, Nolan, Grigginger
& Vecchione
One Riverfront Plaza Newark, New Jersey 07102-5497

Counsel for Appellees

2OPINION OF THE COURT

ALITO, Circuit Judge:

Plaintiffs are a class of past, present, and future insulindependent diabetic inmates ("plaintiffs") whofiled suit claiming that various corrections officials and emp loyees were deliberately indifferent to the plaintiffs' se rious medical needs, in violation of the Eighth Amendment . In this appeal, defendants challenge the District Cour t's refusal to grant summary judgment in their favor on the grounds of qualified immunity. For the reasons disc ussed below, we vacate the District Court's decision and remand for further proceedings in accordance with this opi nion.

I.

In 1990, Darryl Rouse, an insulin-dependent diabeti c then incarcerated at the Adult Diagnostic and Treat ment Center ("ADTC"), a correctional facility in New Jer sey, filed
this S 1983 action. Named as defendants were: Willi am Fauver, Commissioner of the New Jersey Department o f Corrections; William Plantier, Acting Superintenden t of the ADTC; Doctor Robert Cardinale, former Medical Direc tor of ADTC; Doctor Narshima Reddy, former physician at AD TC; and Nurse Elaine Allen, former Chief of Nursing at ADTC. Rouse alleged that the defendants had subjected him to cruel and unusual punishment by failing to provide him with adequate medical care.

In 1994, Rouse amended his complaint and sought cla ss certification, declaratory and injunctive relief fo r the classmembers, and monetary relief for present insulindependent diabetic inmates. See Supp. App. at 18-19 (Amended Complaint).1 The amended complaint alleged that

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1. In the amended complaint, plaintiffs also allege d that defendants had impermissibly discriminated against insulin-depende nt diabetics because of their disability, in violation of the Americans with Disabilities Act,

42 U.S.C. S 12101 et seq. The District Court denied de fendants' motion for summary judgment on the merits of this claim, see R ouse v. Plantier, 997 F. Supp. 575, 582 (D.N.J. 1998), but granted th eir motion on the basis of qualified immunity, Rouse v. Plantier, 987 F. Supp. 302, 317 (D.N.J. 1997). This issue is not on appeal.

3"[t]he defendants have provided class members with

medical care for their diabetes and diabetes-relate d conditions that is so uniformly and grossly inadequ ate as to
constitute deliberate indifference to serious medic al needs in violation of the Eighth Amendment to the United States
Constitution." See Id. at 18.

In 1996, the District Court certified a class consi sting of all former, present, and future insulin-dependent d iabetics incarcerated at the ADTC, pursuant to Federal Rule of Civil Procedure 23(a) and 23(b)(2). For the purpose of cl asswide damages, the District Court also certified a class consisting of all former and present insulin-dependent diabeti cs incarcerated at the ADTC, pursuant to Federal Rules of Civil Procedure 23(a) and 23(b)(3).

Defendants moved for summary judgment on the merits of plaintiffs' claim and, alternatively, on the gro unds of qualified immunity. In support of their respective arguments, both parties submitted the reports of me dical experts. None of the experts disputed that plaintif fs suffer from insulin dependent diabetes mellitus, which all agree is
a serious illness.

Plaintiffs proffered an expert report by Dr. Michae l D. Cohen. See App. at 123-46. Basing his report primar ily on
the American Diabetes Association Clinical Practice Recommendations issued in 1995, Dr. Cohen explained that a characteristic of insulin-dependent diabetes is an abnormally high amount of sugar in the blood due to insulin deficiency, see id. at 123, and that a prim ary goal of disease management, therefore, is to lower the a mount of sugar in the blood to normal or near-normal physiol ogical levels. See Id. at 125. Achieving this goal, Dr. Co hen stated, requires diabetics to engage in a comprehensive dai ly care plan. See Id. at 123 ("Daily management requires cl ose attention to medication, dietary intake and activit y, with frequent monitoring of the blood sugar."). Failure to do so, Dr. Cohen asserted, can cause short-term complicati ons, including excessive urination, constant thirst and hunger, weakness, confusion, dizziness, and seizures, as we ll as severe long-term problems, including blindness, amputation of feet and legs, renal failure, and ner ve damage. See Id.

4Dr. Cohen noted several components necessary for

proper diabetes management. First, he said, diabeti cs require daily injections of insulin, the frequency of which depends upon the severity of the illness. See Id. a t 125-26. Second, he asserted that in order to determine the amount of insulin required, diabetics must monitor their b loodsugar levels at least three to four times each day. See Id. at 126; see also id. at 155 (Report of Plaintiffs' Exp ert, Dr. Mathew J. Miller) ("Dr. Miller's report") (assertin g that "all insulin-requiring diabetics should monitor their bl ood glucose levels on a daily basis" and that the abili ty to test one's blood-sugar level three to four times each da y"is a reasonable standard to which we should aspire"). Th ird, he stated that, in addition to snacks and low-sugar sw eets, diabetics must be given individualized diet plans t ailored to their specific medical needs. See Id. at 127-30; se e also Id. at 156 (Dr. Miller's Report) ("Appropriate food sho uld be provided to each diabetic, the portions and composi tion individualized to needs, size, activity level and s o forth."). Fourth, Dr. Cohen opined that diabetics must be edu cated about their disease and the steps necessary to main tain their health. See Id. at 130; see also id. at 155 ( Dr. Miller's Report) ("[E]ducation is the sine qua non of good d iabetic management."). Fifth, Dr. Cohen stated that timely and effective measures must be taken to prevent long-te rm and chronic complications, such as blindness and loss o f limbs. See Id. at 131-39. For instance, Dr. Cohen noted th at the American Diabetes Association recommends an "[a]nnu al comprehensive dilated eye and vision examination by an opthamologist." See Id. at 134. And finally, he sta ted, clinical and follow-up evaluations must be conducte d on a regular basis to monitor the progression of the dia betic's illness. See Id. at 139-46; id. at 139 ("Special pr imary care needs of diabetics include: comprehensive initial e valuation, regular followup, access to aggressive care for acu te illnesses and injuries, attention to prevention of lung infections[,] and dental care.").

Dr. Cohen evaluated the level of care provided to t he plaintiffs and opined that the defendants had faile d to treat plaintiffs' illness adequately in all material resp ects. See Id. at 146 ("Essential components of necessary care for prisoners with diabetes are missing or inadequate a t

5ADTC."). Dr. Cohen faulted defendants for giving pl aintiffs

one insulin shot per day, despite suggestions from medical consultants that some of the plaintiffs required mo re than one daily injection. See Id. at 126. Dr. Cohen note d that plaintiffs were not provided the opportunity to mon itor their blood-sugar levels on a daily basis and that, in so me cases, blood sugar levels had been tested only 20 times pe r year. See Id. at 125-27. In addition, Dr. Cohen stated th at, among other deficiencies, defendants had not provid ed plaintiffs with individualized meals and had not fu rnished diabetes-appropriate snacks or low-sugar sweets. Se e Id. at 128-30. Dr. Cohen noted further that, other than scheduling one education session several years ago, the defendants had not educated the plaintiffs about th eir illness. See Id. at 130. Last, Dr. Cohen asserted t hat defendants had no comprehensive plan for preventing longterm complications (e.g., inmates are not permitted to visit an eye doctor annually), see id. at 134-35, and tha t the defendants had not established an adequate evaluati on and follow-up program to monitor the progression of the
inmates' illness. See Id. at 139-46. He concluded:

The care and treatment provided to prisoners with diabetes at ADTC is unacceptable by current standards of care. . . . As medical and nursing staff at ADTC are or ought to be aware of the current standard s of care for management of diabetes and the harm that results from inadequate care and treatment, they hav e shown deliberate indifference to the pain and suff ering of prisoners with diabetes.

App. at 124-25.

In response, defendants commissioned a report from Dr. William E. Ryan. Id. at 158-74. Dr. Ryan agreed wit h plaintiffs' expert that diabetes care must be "individualized," but he disputed most of Dr. Cohen 's other assertions. See Id. at 163. Dr. Ryan noted that dia betics whose blood-sugar levels are "known" and "stable" d o not require daily glucose testing. Id. Such testing, he asserted, is only "designed for acute and new diabetics." Id. He noted that the plaintiffs' blood-sugar levels generally h ad remained constant and within normal ranges, i.e, "b etween 125 and 140mg," but he recognized that "many of the

6glucose values were in excess of 200mg, which is le ss than

hoped for and certainly not ideal." Id. at 164. He placed the blame for the increased levels on the plaintiffs, w ho according to Dr. Ryan, had been "uninformed regardi ng their diabetic management when they entered the
institution" and had "thwarted" the staff's efforts to control blood-sugar levels by not complying with their pres cribed diets. Id. at 161, 164. Dr. Ryan further asserted t hat, because each patient at a minimum saw a doctor ever y three months, the care provided at ADTC was "entire ly appropriate" under clinical recommendations. See Id . at 163 ("[R]egular visits (diabetic) should be schedul ed for insulin treated patients at least quarterly . . . . More frequent contact may also be required if the patien t is undergoing extensive insulin therapy . . . ."). Fin ally, Dr. Ryan cited several specific instances in which some of the plaintiffs had received timely and effective medica l treatment. See Id. (explaining that Rouse had recei ved prompt medical treatment when his blood-sugar level increased to an unacceptable level). In sum, he fou nd "no
evidence of deliberate indifference or insensitivit y by the
staff of ADTC in the care of their inmate diabetic patient population." Id. at 170.

Considering the experts' reports, the District Cour t granted summary judgment to Commissioner Fauver on the merits of the Eighth Amendment claim and dismissed as moot the summary judgment motion on the grounds of qualified immunity, concluding that plaintiffs had failed to demonstrate Fauver's culpability. See Rouse v. Plan tier, 987 F. Supp. 302, 312, 315 n.13 (D.N.J. 1997) ("Rouse I "); id. at 312 ("Plaintiffs have not adequately responded t o Defendants' contention that there is no evidence of Defendant Fauver's deliberate indifference."). With respect to the remaining defendants, however, the District Court denied summary judgment on both grounds. See Id. at 312, 315; Rouse v. Plantier, 997 F. Supp. 575, 580 (D.N. J. 1998) ("Rouse II").

The District Court first held that plaintiffs had
demonstrated the existence of material factual issu es on whether the plaintiffs as a class had received constitutionally adequate medical care and constitu tionally

7appropriate diabetes meals. See Rouse I, 987 F. Sup p. at

308-12. The District Court next found that plaintif fs had adduced sufficient evidence for summary judgment purposes that the defendants had been aware of the risks of such inadequacy but had disregarded them. See Id . at 312. Turning to defendants' qualified immunity defe nse, the District Court held that the right at issue was cle arly
established and that the defendants had failed to
demonstrate the reasonableness of their actions. Se e Id. at 313 n.10, 314-15; see also Rouse II, 997 F. Supp. a t 579- 80. Accordingly, it refused to grant summary judgme nt in
their favor.

Defendants moved for reconsideration, and the Distr ict Court again rejected their qualified immunity defen se. See Rouse II, 997 F. Supp. at 579-80. Defendants then t ook this appeal. They challenge only the District Court 's determination that they are not entitled to qualifi ed immunity on plaintiffs' Eighth Amendment claim. We have jurisdiction pursuant to the collateral order doctr ine, see Mitchell v. Forsyth, 472 U.S. 511 (1985), and our r eview is plenary, see Larsen v. Senate of Cmwlth. of Pa., 15 4 F.3d 82, 87 (3d Cir. 1998), cert. denied, 119 S. Ct. 103 7 (1999).

II.

The only issue in this appeal is whether the defend ants are entitled to summary judgment based on qualified immunity. Under this doctrine, "government official s performing discretionary functions generally are sh ielded from liability for civil damages insofar as their c onduct does not violate clearly established statutory or consti tutional rights of which a reasonable person would have know n." Harlow v. Fitzgerald, 457 U.S. 800, 818 (1982). "Th e contours of the right must be sufficiently clear th at a
reasonable official would understand that what he i s doing violates that right." Anderson v. Creighton, 483 U. S. 635, 640 (1987); see also Acierno v. Cloutier, 40 F.3d 5 97, 616 (3d Cir. 1994) (en banc). In determining whether de fendants are entitled to claim qualified immunity, we engage in a three-part inquiry: (1) whether the plaintiffs alle ged a violation of their constitutional rights; (2) wheth er the right alleged to have been violated was clearly establish ed in the

8existing law at the time of the violation; and (3) whether a

reasonable official knew or should have known that the alleged action violated the plaintiffs' rights.

A. We now turn to whether the plaintiffs alleged a violation of their constitutional rights. The Eight h Amendment prohibits the imposition of "unnecessary and wanton infliction of pain contrary to contemporary standards of decency." See Helling v. McKinney, 509 U.S. 25, 32 (1993). In Estelle v. Gamble, 429 U.S. 97 (1 976), the Supreme Court held that the Eighth Amendment's prohibition against cruel and unusual punishment re quires prison officials to provide basic medical treatment to those
whom it has incarcerated. The Court articulated the

standard to be used:

In order to state a cognizable claim, a pris oner must allege acts or omissions sufficiently harmfu l to
evidence deliberate indifference to serious medical needs. It is only such indifference that can offend "evolving standards of decency" in violation of the Eighth Amendment.

Id. at 106. Therefore, to succeed under these princ iples, plaintiffs must demonstrate (1) that the defendants were deliberately indifferent to their medical needs and (2) that those needs were serious. Id. The defendants agree that insulin-dependent diabetes mellitus is a serious il lness, and therefore only the former question is in issue here

.

It is well-settled that claims of negligence or med ical malpractice, without some more culpable state of mi nd, do
not constitute "deliberate indifference." As the Es telle Court noted: "[I]n the medical context, an inadvertent fa ilure to provide adequate medical care cannot be said to con stitute `an unnecessary and wanton infliction of pain' or t o be `repugnant to the conscience of mankind.' " Id. at 105; see also Durmer v. O'Carroll, 991 F.2d 64, 67 (3d Cir. 1993) ("[T]he law is clear that simple medical malpractic e is insufficient to present a constitutional violation. "); White v. Napoleon, 897 F.2d 103, 110 (3d Cir. 1990) (emphasi s omitted) ("[C]ertainly no claim is stated when a do ctor disagrees with the professional judgment of another doctor. There may, for example, be several acceptable ways to treat

9an illness."). "Deliberate indifference," therefore , requires

"obduracy and wantonness," Whitley v. Albers, 475 U .S. 312, 319 (1986), which has been likened to conduct that includes recklessness or a conscious disregard of a serious risk. See Farmer v. Brennan, 511 U.S. 825, 842 (199 4) (stating that "it is enough that the official acted or failed to act despite his knowledge of a substantial risk of serious
harm").

We have found "deliberate indifference" in a variet y of circumstances, including where the prison official (1) knows of a prisoner's need for medical treatment but inte ntionally refuses to provide it; (2) delays necessary medical treatment based on a non-medical reason; or (3) prevents a pr isoner from receiving needed or recommended medical treatm ent. See Durmer, 991 F.2d at 68 (citing Monmouth County Corr. Inst. Inmates v. Lanzaro, 834 F.2d 326, 346-47 (3d Cir. 1987), cert. denied, 486 U.S. 1006 (1988)). We also have
found "deliberate indifference" to exist where the prison official persists in a particular course of treatme nt "in the face of resultant pain and risk of permanent injury ." Napoleon, 897 F.2d at 109-11 (holding that allegati ons of
several instances of flawed medical treatment state a claim under Eighth Amendment).

In reaching its conclusion that the plaintiffs had alleged a violation of their Eighth Amendment rights, the D istrict Court relied on the experts' reports submitted by t he parties. The Court first found that genuine issues of material fact existed on whether the plaintiffs wer e "served a meal appropriate for their diabetic condition." R ouse I, 987 F. Supp. at 308. The Court noted the "numerous deficiencies" cited by plaintiffs' expert, includin g (1) lack of portion control, (2) unavailability of diabetes-app ropriate meals, snacks, and low-sugar foods, and (3) failure to individualize diets. Id. Next, the Court found that genuine
issues of material fact existed on whether the leve l of care provided to plaintiffs was constitutionally adequat e. Id. at 310. Observing that some of the plaintiffs had thei r bloodsugar levels tested only a minimal number of times each year, the Court refused to conclude, as a matter of law, that defendants had provided appropriate medical care. I d. at 311-12. Noting several additional deficiencies, 2 t he District

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2. Specifically, the District Court noted that genu ine issues of fact existed on "1) the adequacy of care of Rouse and Br ooks' feet; 2) the

10Court concluded that "the risks of inadequate treat ment

were obvious to a reasonably well-trained doctor, n urse, or prison official" and that the defendants "were subj ectively aware of the risks . . . but did not respond reason ably." Id.
at 312.

On appeal, defendants contend that the evidence demonstrates that plaintiffs were provided with"ext ensive care" that did not "fall short of that required by the Eighth Amendment." Appellants' Br. at 41, 37. Specifically
, defendants note that not "all" insulin-dependent di abetics require "routine daily blood-sugar testing." Id. at 33 (emphasis in original). They point to a lack of evi dence indicating that the number of blood-sugar tests per formed each year and the diabetic meals provided each pati ent were inappropriate for any of the particular plaint iffs' diabetic condition. See Id. at 34, 37 ("[P]laintiff s cannot demonstrate . . . that . . . the frequency of sugar testing for their particular medical condition so threatened th eir health [that it] subjected them to cruel and unusua l punishment. . . . Plaintiffs [also] have presented absolutely no evidence that they cannot maintain their health based on [the] diets [provided].").

Plaintiffs, on the other hand, contend that the defendants' systemic failure to provide a constitut ionally adequate level of care reflected a deliberate indif ference to the plaintiffs' serious medical needs. See Appellee s' Br. at 16. Such failure, they maintain, is evidenced by th e defendants' refusal to provide a level of care even approximating that required by accepted medical pra ctices. See Id. They further contend that "only an official who was deliberately indifferent to the serious medical nee ds of diabetic inmates could have participated in, and no t objected to, the constitutionally deficient system of diabetic

care at ADTC." Id. at 23-24.

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adequacy of the eye care provided, particularly, wh ether any preventive care is provided; 3) the adequacy of measures to pr event other relatively common diabetes-specific complications, such as kid ney damage, nerve damage, or blood vessel damage; 4) the existence of and need for diabetic education." Rouse I, 987 F. Supp. at 311 (citations omitted).

11Considering the principles enunciated in Estelle a nd its

progeny, we find that the District Court erred in c oncluding on a wholesale basis that the plaintiffs alleged a violation of their Eighth Amendment rights. The experts' reports make clear that not all insulin-dependent diabetics requ ire the same level of medical care. The reports show that t here are at least two groups of insulin-dependent diabetic p laintiffs in this case. The first group consists of those ins ulindependent diabetics whose blood sugar levels consis tently fluctuate to abnormal levels (i.e., the "unstable" plaintiffs). These diabetics require intensive medical treatment in order to regulate their blood sugar levels to normal or n ear normal physiological levels, which, as the experts' reports demonstrate, is the primary goal of diabetes manage ment. The other group is comprised of those insulin-depen dent diabetics whose blood sugar levels remain at or nea r normal physiological levels over time (i.e., the"st able" plaintiffs). These individuals have already achieve d the primary goal of diabetes management and therefore d o not require the same level of intensive medical treatme nt as their unstable counterparts. Consequently, it is po ssible that conduct that violates the Eighth Amendment rig hts of the unstable plaintiffs may not violate the constit utional rights of the stable plaintiffs.

In light of the diverse medical needs of, and the d ifferent level of care owed to, each group of plaintiffs, th e District Court erred in holding that all members of the plai ntiff class alleged a violation of their Eighth Amendment rights. Based on the evidence in the summary judgment recor d, there may be one or more subgroups of plaintiffs as to whom particular aspects of the care allegedly provi ded was not consistent with Eighth Amendment requirements a nd other subgroups as to whom particular aspects of th e care was constitutionally adequate. On remand, therefore , the Court should address the specific needs of each suc h group, considering, for instance, the appropriate a mount of glucose testing, the need for a special diet, and t he plaintiffs' general compliance with their medical appointments and prescribed dietary plans. Then, th e District Court should consider the appropriate leve l of care due under the Eighth Amendment. Only after the latt er determinations are made should the District Court

12determine whether the defendants' actions with resp ect to

each of these matters and with respect to each rele vant subgroup of plaintiffs were consistent with the req uisite level of care owed under the Eighth Amendment at th e times in question.

We note that this case presents an unusual situatio n-- an Eighth Amendment class action for damages in whi ch the defendants asserted the defense of qualified im munity -- and that prior circuit precedent did not provide the District Court with guidance as to how the defendan t's qualified immunity claim should be handled in this context. The constitutional right asserted by the plaintiff class -- the Eighth Amendment right of a prisoner to be free fro m deliberate indifference to his or her serious medic al needs -- is one that obviously varies depending on the me dical needs of the particular prisoner. Yet here, the pla intiff class is a medically diverse group. Moreover, the violati ons for which damages are sought allegedly occurred over a span of years, during which the relevant medical standar ds may have changed. And, as we will discuss below, the defendants also vary, including both a lay supervis or and medical professionals. If this case ultimately goes forward as a class action for purposes of damages,3 the sco pe of the qualified immunity afforded each individual defenda nt should not be any different than it would be if tha t defendant were instead faced with separate damages actions filed on behalf of each member of the plain tiff class. Thus, if an individual damages actions by plaintiff P1 against defendant D1 would not survive a motion for summary judgment based on qualified immunity, eithe r because D1's alleged conduct did not constitute an Eighth Amendment violation as to P1 or because the illegal ity of D1's conduct was not clearly established at the tim e in question, then in the class action context D1 shoul d likewise be free from the burden of going to trial on the claims of P1 and all other similarly situated membe rs of the plaintiff class. For these reasons, we remand to th e District
Court for it to consider the individual needs of ea ch relevant subgroup of plaintiffs.

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3. The question of class certification for purposes of damages is not before us, and we express no opinion on this issue.

13B. In light of the fact that we are remanding this case to

the District Court to determine in the first instan ce whether relevant subclasses of plaintiffs have alleged viol ations of their Eighth Amendment rights, it would be prematur e for us to address the question whether, if such violati ons are ultimately found to have been alleged, the illegali ty of the defendants' conduct was clearly established. Howeve r, we emphasize that the District Court on remand should not only address the situation of each relevant categor y of plaintiffs, but it should also analyze separately t he
situation of each of the defendants who is sued for damages in an individual capacity.

As previously noted, when a defendant asserts the defense of qualified immunity, it is necessary to d etermine whether a reasonable official in the position of th at
defendant would have known that his or her actions were unconstitutional in light of the clearly establishe d law and the information the official possessed. See Anderso n v. Creighton, 483 U.S. 635, 641 (1987) (determining wh ether it was objectively reasonable for an official to be lieve that a particular search was supported by probable cause r equires consideration of the information possessed by the s earching officials). In making this determination in this ca se, the District Court went astray in two respects.

First, the District Court should have addressed the specific conduct of each of the individual defendan ts in determining whether that particular defendant acted in an "objectively unreasonable" manner. In Grant v. City of Pittsburgh, 98 F.3d 116, 122 (3d Cir. 1996), we obs erved that the determination of whether a government offi cial has acted in an objectively reasonable manner demands a highly individualized inquiry. We stated:

[T]he question is whether a reasonable publi c official would know that his or her specific conduct violated clearly established rights . . . . Thus, cru cial to the resolution of any assertion of qualified imm unity is a
careful examination of the record . . . to e stablish, for purposes of summary judgment, a detailed fac tual description of the actions of each individua l defendant

. . . .

14Id. at 121-22 (emphasis in original); see also Reit z v.

County of Bucks, 125 F.3d 139, 147 (3d Cir. 1997) ( stating that qualified immunity analysis "requires applicat ion of the law to the particular conduct at issue"); Bakalis v

. Golembeski, 35 F.3d 318, 326-27 (7th Cir. 1994) ("Q ualified immunity is an individual defense available to each individual defendant in his individual capacity."); Waldrop v. Evans, 871 F.2d 1030, 1034 (11th Cir. 1989) (eva luating challenged conduct individually because deliberate indifference standard is fact-specific).

In the present case, the District Court determined, without an individualized explanation, that all of the defendants (except Commissioner Fauver) had acted i n an objectively unreasonable manner. The District Court simply stated that "[d]efendants knew what the appropriate level of
care for a diabetic was and knew that the level of care provided was far short of it." Rouse I, 987 F. Supp . at 315. Nowhere in the District Court's opinion did it anal yze the specific actions of each of the individual defendan ts. Nor is there any evidence in the record that allows us to make this determination on appeal.

The need for an individualized analysis is apparent in this case because one of the individual defendants, the acting superintendent, is a lay administrative offi cial. It is well-settled that liability under S 1983 may not be based on the doctrine of respondeat superior, see Durmer v. O'Carroll, 991 F.2d 64, 69 n.14 (3d Cir. 1993), and there is nothing in the record or the District Court's opini on setting forth the basis for the conclusion that the acting superintendent should have known that his conduct constituted an Eighth Amendment violation.

Second, the District Court should have considered t he
reasonableness of each of the defendants' actions w ith respect to each of the relevant categories of plain tiffs. The
District Court stated:

[K]nowing that glucose is normally tested at the very least once a day for patients like Plaintiff s, Defendants could not have reasonably believed that gluc ose testing in many cases less than twenty times a year for these particular Plaintiffs was reasonable medical care . . . .

15Defendants could not . . . have reasonably t hought that

Plaintiffs were among the group of insulin-d ependent diabetics who could tolerate such infrequent testing, given . . . the substantial evidence of seri ous fluctuations in the glucose levels of some o f the plaintiffs . . . .

Rouse I, 987 F. Supp. at 315 (emphasis added) (emph asis in original omitted). As that paragraph demonstrate s, the District Court recognized that not all of the plain tiffs are similarly situated but proceeded nevertheless to co nsider the plaintiffs' claim on a classwide basis. As disc ussed earlier, this analysis may have subjected some of t he defendants to the possibility of personal liability even though the care they provided may have been constitutionally sufficient.

Therefore, the District Court's determination that all of the defendants failed to act in an objectively reas onable manner in the care that they provided to all of the plaintiffs cannot stand. Accordingly, we remand to the Distric t Court
for it to determine whether each of the individual defendants acted in an objectively reasonable manne r with respect to the particular needs of each relevant gr oup of plaintiffs.

III.

For these reasons, we vacate the decision of the Di strict Court and remand for the Court to reevaluate the qu alified immunity issue in accordance with this opinion.

A True Copy:

Teste:

Clerk of the United States Court of Appeals
for the Third Circuit

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